[Biometric characteristics of the lacrimal passages in healthy individuals and in patients with nasolacrimal duct obstruction]. / Biometricheskie kharakteristiki slezootvodyashchikh putei v norme i pri dakriostenoze.

Despite an obvious interest in the processes occurring in the lacrimal passages in their obstruction, there is few articles analyzing their biometric parameters. PURPOSE: The study investigates the biometric characteristics of the lacrimal passages in healthy individuals and in patients with nasolacrimal duct obstruction. MATERIAL AND METHODS: The study included 81 cases of partial nasolacrimal duct obstruction and 38 cases without tear drainage insufficiency. All patients underwent computed tomography with dacryocystography. Analysis of the biometric parameters involved calculation of the length, volume, and average sectional area of the nasolacrimal duct and the nasolacrimal bony canal. The ratio R4/16l was calculated (where R is the radius of the nasolacrimal duct; l is the length of the nasolacrimal duct). The normality of values was assessed using the Shapiro-Wilk test. Intergroup differences were assessed using the Mann-Whitney test and t-statistics for independent samples. Correlation analysis was performed according to the Spearman method. ROC analysis was carried out. Differences were considered significant at p≤0.05. RESULTS: There were significant differences in the volume (p=0.004) and the average sectional area of the nasolacrimal duct (p=0.014), as well as in the length of the nasolacrimal canal (p=0.034). Relationships were established between the age of patients without tear drainage insufficiency and the length of the nasolacrimal canal (p=0.042); the length of the nasolacrimal canal and the volume of the nasolacrimal duct (p=0.034), as well as the volume of the nasolacrimal duct and the nasolacrimal canal in partial nasolacrimal duct obstruction (p=0.017). The AUC of the R4/16l ratio in the ROC analysis was 0.653 (p=0.007). CONCLUSION: In addition to the obvious differences, it was found that the length of the nasolacrimal bony canal significantly differed in the subjects of both study groups. We considered the tear ducts as a hydrodynamic system obeying Poiseuille's law, so we calculated the ratio R4/16l. The value of this ratio varied (p=0.016), and the ROC analysis showed high sensitivity and specificity of the criterion. This makes it possible to use this ratio as a diagnostic criterion for partial nasolacrimal duct obstruction.

[The impact of the position of toric intraocular lenses on the functional outcomes of phaco surgery]. / Vliyanie polozheniya toricheskikh intraokulyarnykh linz na funktsional'nye rezul'taty fakokhirurgii.

The article reviews data on the impact of the position (orientation) of toric intraocular lenses on the functional outcomes of cataract phacoemulsification surgery, discusses the algorithm of astigmatism correction with intraocular lenses including preoperative determination of the size and position of main meridians, calculation of lens parameters, marking of corneal meridians, intraoperative positioning, as well as rotation and/or repositioning of the lens when necessary.

[Differentiated method of surgical prophylaxis against anterior capsular contraction syndrome during phacoemulsification]. / Differentsirovannaya metodika khirurgicheskoi profilaktiki kapsulyarnogo kontraktsionnogo sindroma v khode fakoemul'sifikatsii.

Prevention of the anterior capsular contraction syndrome (ACCS) in the late postoperative period in patients with lens subluxation is a current problem of phacoemulsification (PE). PURPOSE: To develop and clinically evaluate a differentiated method of surgical prophylaxis against ACCS during PE in patients with lens subluxation. MATERIAL AND METHODS: Phacoemulsification surgery with in-the-bag IOL implantation and postoperative follow-up were carried out in 192 patients (192 eyes) with cataract and lens subluxation. In all patients, complete anterior capsulorhexis at the beginning of the surgery was not possible. A differentiated approach was used for capsulorhexis extension at the final stage of the operation after in-the-bag IOL implantation. Three groups of patients were formed according to the three most common clinical situations. RESULTS: There were no signs of ACCS development in as many as 189 (98.4%) cases. In 3 (1.6%) cases, slight narrowing of the anterior capsulorhexis opening was noted, however, with no effect to the IOL position and functional results of the operation. CONCLUSION: The differentiated approach to anterior capsulorhexis in patients with lens subluxation allowed to perform phacoemulsification with in-the-bag IOL implantation and to avoid ACCS development in the late postoperative period.

[Evolution of IOL exchange. Part 2. Modern problems of IOL exchange]. / Evolyutsiya reimplantatsii intraokulyarnykh linz. Chast' 2. Sovremennye problemy reimplantatsii intraokulyarnykh linz.

The review discusses modern problems of intraocular lens (IOL) exchange. Making an adequate choice between IOL reposition and IOL exchange in pseudophakic patients with problems of lens fixation remains a largely unsolved issue. The literature data shows a noticeable increase in the number of supporters of retropupillary fixation of an iris-claw lens during the exchange procedure.

[Comparative evaluation of positional stability of the «capsular bag + intraocular lens¼ complex in patients with lens subluxation]. / Sravnitel'naya otsenka stabil'nosti polozheniya kompleksa «kapsul'nyi meshok + intraokulyarnaya linza¼ u bol'nykh s podvyvikhom khrustalika.

Prevention of decentration and dislocation of the "capsular bag + intraocular lens" (IOL) complex in the late postoperative period is an actual problem of surgical treatment of patients with pronounced lens subluxation. PURPOSE: To conduct a comparative clinical study of positional stability of the "capsular bag + IOL" complex in the late postoperative period after application of a combined technique of capsular bag fixation in patients with subluxation of the lens. MATERIAL AND METHODS: Phacoemulsification (PE) with in-the-bag IOL implantation and postoperative observation was performed in 213 patients (234 eyes) with cataract and pronounced lens subluxation. The 1st group consisting of 138 patients (153 eyes) underwent capsular bag fixation of the combined technique with simultaneous use of 4 modified iris-retractors and one or two capsular tension rings (CTRs). The 2nd group included 75 patients (81 eyes) who in the course of PE had their capsular bag fixed beyond the edge of capsulorhexis with only 4 modified iris-retractors. Preoperative state of the lens and the evaluation of the frequency and degree of decentration of the «capsular bag + IOL¼ complex in the postoperative period were performed using data acquired with ultrasound biomicroscopy (UBM). RESULTS: Significant (more than 1 mm according to UBM) IOL's optic decentration was observed in the 1st group after applying the combined capsular bag fixation technique in 12 (7.8%) cases, and in the 2nd group after isolated use of modified iris-retractors in 48 (59.3%) cases. CONCLUSION: The use of the combined capsular bag fixation technique not only improves the conditions for carrying out PE with in-the-bag IOL implantation in patients with pronounced lens subluxation, but also contributes to a substantial (an average of 8 times) reduction in the incidence of significant decentration of the «capsular bag + IOL¼ complex in the late postoperative period.

[Energy load and state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification]. / Énergeticheskaia nagruzka i sostoianie éndoteliia rogovitsy pri gibridnoi (femtolazernoi) i torsionnoi fakoémul'sifikatsii.

Postoperative state of the corneal endothelium is the most important criterion for evaluating the safety of cataract phacoemulsification. PURPOSE: To compare the intraoperative energy load and postoperative state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification. MATERIAL AND METHODS: The study analyzed surgical outcomes of 603 patients (714 eyes) divided into 3 groups: 225 patients (267 eyes) underwent modified femtosecond laser-assisted phacoemulsification (1st group), 237 patients (278 eyes) underwent standard femtosecond laser-assisted phacoemulsification (2nd group), and 141 patients (169 eyes) who underwent torsional phacoemulsification (3rd group). The follow-up period lasted up to 2 years. RESULTS: In patients with grade II lens density (here and further - L. Buratto classification is used), effective ultrasound time was 0.56±0.11 s in the 1st group, 0.83±0.17 s in the 2nd group, and 2.78 ± 0.51 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade III lens density effective ultrasound time was 2.04±0.37 s in the 1st group, 2.97±0.53 s in the 2nd group, and 4.59±0.91 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, effective ultrasound time was 3.95±0.81 s in the 1st group, 5.11±1.03 s in the 2nd group, and 8.37±1.73 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade II lens density, loss of endothelial cells was 3.3±1.1% in the 1st group, 3.7±1.2% in the 2nd group, and 4.3±1.2% in the 3rd group (p(1-2)>0.05; p(1- 3)<0.05; p(2-3)<0.05). In patients with grade III lens density, loss of endothelial cells was 5.1±1.4% in the 1st group, 5.7±1.5% in the 2nd group, 7.2±1.7% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, loss of endothelial cells was 8.9±2.1% in the 1st group, 10.1±2.3% in the 2nd group, and 13.3±2.5% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2- -3)<0.05). CONCLUSION: Both techniques of femtosecond laser-assisted phacoemulsification significantly reduce the effective ultrasound time (p<0.05) and the degree of corneal endothelial cells loss (p<0.05) compared with torsional phacoemulsification.

[Prevention of intraoperative miosis in femtosecond laser-assisted phaco surgery]. / Preduprezhdenie intraoperatsionnogo mioza v fakokhirurgii c primeneniem femtosekundnogo lazera.

INTRODUCTION: Prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification is a relevant problem of cataract surgery. PURPOSE: Development and clinical study of an effective method for preventing intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification. MATERIAL AND METHODS: Hybrid phacoemulsification was performed in 300 patients (300 eyes). The first group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day and 3 times in 2 hours before surgery at 30 minute intervals. The second group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day, 3 times in 2 hours before the surgery at 30 minute intervals, and 1 hour before the surgery an additional intramuscular injection of diclofenac. The third group (control, 100 eyes) 2 hours before the operation was prescribed instillations of 0.1% indomethacin, 3 times at 30 minute intervals. The diameter of the pupil was evaluated before the beginning of femtosecond laser stage and before the opening of anterior chamber during the second stage of the operation. RESULTS: When the interval between the femtosecond laser stage and emulsification of the nucleus fragments was maintained at less than 15 minutes, pronounced decrease of the pupil (more than 2 mm) was noted in 8.2% of cases in the first group, 6.7% in the second group and 14.1% in third (control) group; mean values of pupil narrowing were 0.68±0.27 mm in the 1st group, 0.63±0.25 mm in the 2nd group, and 0.93±0.39 mm (p<0.05) in the third group. CONCLUSION: The clinical study showed high efficiency of the proposed methods for prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phaco surgery. An important factor affecting intraoperative narrowing of the pupil is the time interval between the femtolaser stage of the operation and emulsification of the nucleus fragments, which should not exceed 15 minutes.

[Morphofunctional changes and complications after out-of-the-bag intraocular lens implantation]. / Morfofunktsional'nye izmeneniia i oslozhneniia vnekapsul'noi implantatsii intraokuliarnoi linzy.

The article reviews morphofunctional changes and complications after using modern methods of out-of-the-bag implantation of the intraocular lens (IOL). Literature data shows that the smallest morphofunctional changes in intraocular structures and the best results are obtained after retropupillary implantation of an iris-claw lens and transscleral fixation of posterior chamber IOL.

[Surgical technique of retropupillary iris-claw fixated IOL reimplantation]. / Khirurgicheskaia tekhnika reimplantatsii intraokuliarnoi linzy s retropupilliarnoi fiksatsiei.

Prevention and treatment of cataract surgery complications in patients with lens subluxation remains one of the current problems of phaco surgeries. PURPOSE: To develop and to test the surgical technique for reimplantation of in-the-bag dislocated intraocular lenses (IOL) or sulcus-fixated IOL. MATERIAL AND METHODS: Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus fixated IOL dislocation (28 eyes) were analyzed. The follow-up period lasted 1-3 years. RESULTS: In all cases the dislocated IOL was removed and retropupillary iris-claw 'Artisan' IOL implantation was performed. After the IOL exchange, visual acuity improved in all patients, while the fixation of retropupillary IOL remained stable. CONCLUSION: This surgical technique of dislocated IOL exchange coupled with retropupillary implantation of 'Artisan' IOL provides reliable anatomic and functional results.

[Results of secondary retropupillary-fixated intraocular lens implantation]. / Rezul'taty reimplantatsii intraokuliarnoi linzy s retropupilliarnoi fiksatsiei.

Surgical treatment of intraocular lens (IOL) with late dislocation remains one of the current problems of ophthalmology. PURPOSE: To evaluate specific morphofunctional changes in the eye after dislocated IOL exchange with retropupillary-fixated iris-claw IOL. MATERIAL AND METHODS: Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus-fixated IOL dislocation (28 eyes) were analyzed. The follow-up period was 1-3 years. RESULTS: Increase in visual acuity and stable retropupillary fixation of the IOL was observed in all cases after reimplantation. Mean endothelial cell loss after 3 months was 6.9±1.3% in the group with preoperative density of >1200 cells/mm2 and 12.3±2.7% in the group with preoperative density of <1200 cells/mm2. There was no significant increase in intraocular pressure after IOL reimplantation. The incidence of clinical cystoid macular edema with decreased visual acuity was 4.7%, which is significantly more frequent than in patients after uncomplicated phacoemulsification with in-the-bag IOL implantation. CONCLUSION: Retropupillary implantation of iris-claw IOL provides stable fixation, good functional outcomes with low complication rates and is suitable for reimplantation in eyes without adequate capsular support.